You Under My Skin

To have and to hold, to nip and to tuck…when spouses become clients

There's a saying in plastic surgery that if you want to judge a doctor's work, look at his wife. Doctors of all kinds confront the issue of treating family members: Should something go wrong, how could one be sure emotions wouldn't get in the way of taking life-saving action? But a plastic surgeon's decision to cut into the person he or she loves most can be particularly charged, even creepy, especially when it comes to reshaping her face.

"The face is the most anxiety-provoking," says David P. Rapaport, MD, a New York City plastic surgeon who has operated on his mother-in-law, his sister, and his wife. "But I love my wife's face even more now, because I know I had a part in it." The American Society for Aesthetic Plastic Surgery takes no official stance on operating on a family member, though Robert H. Aicher, the society's legal counsel, says it's "not recommended." But, in truth, there's operating on your wife, and then there's operating on your wife to the point at which she becomes a walking billboard for every item on your service menu. "Doctors will have their trophy wives number four, five, and six, with the large breasts and the large lips," says Kevin L. Smith, MD, of Charlotte Plastic Surgery in North Carolina. "And you have to ask, Who are they doing that for?" Their wives or themselves?

Steven Fayer, MD, an assistant clinical professor of psychiatry at Mt. Sinai Medical Center in NYC, has even been asked to see the wives of plastic surgeons by the plastic surgeons themselves, to discuss the psychological ramifications. "One doctor was just a very sensitive guy," Fayer says. "He wanted to get the go-ahead for the right reasons. After examining his wife, I didn't feel she had any significant emotional difficulties. Also, she was 51. If she were 25, then I would have been suspicious."

Rapaport's wife, Charmaine, was initially surgery-averse. But after having four children, she decided she wanted to talk to her husband about liposuction. "I remember thinking, Maybe I'll just ask him what the risks are. I thought he'd say, `I have to refer you to a friend because I can't bear to see you in pain or bleeding,'" she recalls. "But he said, `There's a cancellation next Friday.' He seemed so fine with it that I thought, Wait, are you that detached?" She adds, "I think he accepted me as a patient in a protective way."

It's a truism that surgeons are not generally egoless beings, and when a doctor is doing a procedure because his wife wants it done, he likely feels he is the best person for the job, says Sheenah Hankin, a New York City psychotherapist who has counseled patients pre-surgery. "It depends how secure [the wife] is. If you're saying, `By improving my face, you give me approval,' it's probably not a good idea. But if she wants to look younger and fresher, and it's not a purely emotional decision, why not?"

Part of the motivation to get work done is the pressure to represent. "As soon as people know what he does for a living, their eyes are riveted on me," says Leigh Brown, whose husband, Elliot Jacobs, MD, a Manhattan plastic surgeon, has operated on her twice. "They practically take out microscopes! So I like to look as good as I can."

"You start to think, Am I agreeing I need to do this because it might make his business look better?" asks the wife of one New York City-based surgeon whose husband gave her a breast augmentation and a neck-lift. "I often think I should go to one of their national meetings and lead group therapy sessions for the wives."

But the most obvious reason a wife might be tempted to go under her husband's knife may simply be because it's convenient...and cheap. Not to mention discreet. Most plastic surgeons operate in their own fully accredited operating rooms, which means privacy above all. Injectables can be brought home and stored in the fridge or even taken on vacation. "We went to a wedding in Boston," says a 33-year-old mother of two who is married to a Miami surgeon, "and my husband was giving me Botox an hour before the ceremony while I was sitting on the kitchen counter. My daughter held the instruments." A few months prior, he increased her A-cups to C-cups and suctioned one liter of fat from her thighs.

"This is not out of the norm," says Manhattan's Paul Z. Lorenc, MD, who has operated on both his wife and his mother-in-law. "I think it is the norm."

Jody Alpert Levine, MD, a pediatrician and dermatologist, shares a New York City practice with her husband, Elie Levine, MD, a plastic surgeon. They're both in their thirties, and the issue of who would do work on the other has yet to come up. But they've already decided that they're comfortable only with injectables and minor procedures. "Five years from now," he says, "if I decided I wanted some laser resurfacing, I'd probably be okay with Jody doing that to me, and I think I'd be comfortable doing that to her." But they draw the line at anything involving more than local anesthesia. "Elie would get me the best results," she says, "but there should be a separation between your spouse and your work. I feel that way about my kids. I trust my own opinion, yet I force myself to bring them to another doctor."

And although shapely new breasts or a six-pack-etched stomach could reignite a decades-old sex life, Alpert Levine isn't convinced that once a spouse has seen the unsexy insides—sinewy muscle, yellowish gelatinous fat, and all—of his beloved's body that those images could ever be erased. "Would I want my body, which is a sexual object to my husband, suddenly to become just an anatomical part?" she asks. "Elie's said to me, `It wouldn't change a thing.' Even so, I wouldn't want to take the chance."

There's also potential emotional injury to contend with when your spouse is the one scrutinizing your profile or analyzing your saddlebags. "The negative is, what if your husband thinks you need bigger breasts, but you thought your breast size was adequate," says psychiatrist Fayer. "Then you think, He doesn't love me the way I thought, and, Maybe he really is desirous of a different physical type."

When one wife went to her husband to get liposuction around her hips, "there he was with a big magic marker, putting circles on my hips, below my butt, and on the inside of my thighs!" she says. "He told me if he didn't do those areas, too, I'd be back in six months asking for it. I just swallowed my pride. But it's like, can't we both just age together, with our wrinkles and our fat?"

Yet many wives interviewed for this article, far from being demoralized, said they came away from their experiences feeling they'd given their marriages an emotional boost. When Lorenc took care of his wife, Lorraine, after performing her rhinoplasty, "It was a side of him I'd never seen before," she says. "He was washing my hair in the sink. I get to be a patient and feel the gentle kindness."

Last October, when Jacobs prepared to perform a face-lift on Brown, he says that within two minutes, he'd entered what he calls "the zone," and his wife's face became a surface, like any other, to slice and tighten. Still, "when the last stitch went in," Jacobs says, "I thought, I'm glad it's over." Brown, echoing Lorenc, recalled how her husband became her nurse-in-residence, making her chicken soup and spending the entire weekend attending to her aches and pains. The whole experience, she says, "developed that love and trust." Her husband was similarly satisfied, though happy to have gotten it over with. "If something goes wrong, you have to live with it every single day," he says. "And there could be resentment. All that is totally valid. But you can also look at it the other way: Who knows her face better than I do?"

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